Facial Feminization Surgery (Gender-Affirming Surgery)

Facial feminization surgery includes a holistic set of procedures designed to give the face a more typically feminine appearance. This can include alterations to the hairline, forehead, brow, nose, jaw, chin and neck.

Whether to have FFS is an immensely personal decision. Having surgery is not a need or desire for all transgender or gender non-conforming people. But for some, such interventions can profoundly help their sense of self and outer appearance align, easing discomfort associated with gender dysphoria, improving confidence, and altering the dynamics of social interactions.

One aspect of considering FFS is determining the optimal timing. This type of care may be coordinated with hormone therapy for individuals undergoing broader gender-affirming medical transitions. Surgeons often recommend waiting until hormonal effects have stabilized before proceeding with FFS. This typically occurs after one to two years of hormone therapy.

While FFS offers a more definitive and permanent change in facial appearance, there are less invasive and more temporary options for altering the contours of the face, including Botox® and other injectables.

It is crucial for you to consult with your healthcare providers, including FFS specialists, to determine the most appropriate approach and timing for facial surgery. Be sure to discuss realistic outcomes, as well as all attendant benefits and risks.

The range of FFS procedures that may be considered is diverse. Key components include scalp hairline advancement, forehead contouring, a brow lift, rhinoplasty, jaw and chin contouring, and tracheal chondroplasty (Adam’s apple reduction).

Scalp hairline advancement involves moving the hairline forward to reduce a high forehead, creating a more traditionally feminine hairline shape. Forehead contouring reshapes the brow ridge by shaving down the frontal bone, resulting in a smoother, more rounded forehead. A brow lift raises the position of the eyebrows, giving a more youthful and feminine arch to the upper face.

Rhinoplasty, or nose reshaping, adjusts the size and shape of the nose to align with feminine facial aesthetics; this often includes refining the bridge, tip, and nostrils. Jaw and chin contouring involves reshaping the jawline and chin to soften and narrow these features, achieving a more delicate and less angular look.

Tracheal chondroplasty, also known as Adam’s apple reduction, involves shaving down the thyroid cartilage to reduce the prominence of the Adam’s apple, further contributing to a feminine neck contour.

Each procedure should be customized to the individual’s unique facial structure and aesthetic goals, ensuring a harmonious and natural-looking result. The combination of these surgeries can significantly enhance the overall femininity of the face, helping to alleviate gender dysphoria and promote greater alignment between one’s appearance and gender identity.

Before you go

During a facial feminization surgery consultation, your surgeon will evaluate your facial structure, discuss your aesthetic goals, and review your medical history, including any hormone therapy you have undergone.

Your surgeon will explain various procedures, such as scalp hairline advancement, forehead contouring, brow lift, rhinoplasty, jaw and chin contouring, and tracheal chondroplasty. Prepare for this consultation by listing your goals and any concerns.

Review before-and-after photos to understand potential results and ask about the risks, recovery process, and expected outcomes. Your surgeon may use imaging technology to visually represent potential results, helping you understand what to expect.

If you and your healthcare providers decide that the timing is right to begin FFS, another key consideration is whether to have all related procedures at the same time or spaced out over a period of months. This decision depends on the complexity and extent of the desired changes. In some cases, a comprehensive facial feminization surgery can be achieved in a single session. For more extensive procedures, or when patients prefer a phased approach, multiple sessions may be recommended. This allows for a more gradual transformation, giving individuals time to adjust both physically and emotionally between procedures.

These discussions will help create a personalized surgical plan that aligns with your vision for a more authentic and affirming facial appearance.

During the procedure

On the day of your facial feminization surgery, you’ll meet with your surgeon to review the final plans and with the anesthesiologist to discuss anesthesia, ensuring you’re comfortable throughout the procedure. The surgery will be performed under general anesthesia to avoid any pain.

While FFS is typically done on an outpatient basis, undergoing multiple procedures can make for a lengthy day, requiring an overnight stay at a recovery center, hospital, or ambulatory surgery center (ASC). After surgery, you will be taken to a recovery room, where medical staff will monitor you as you recuperate. Once stable, you will either be discharged home or transferred to a recovery facility for further observation.

Facial Feminization Surgery Aftercare 

Recovery from facial feminization surgery involves several stages. In the first week, you will typically experience swelling, bruising, and discomfort, which can be managed with over-the-counter or prescribed medications. It is crucial to follow post-operative care instructions to promote healing and reduce infection risks.

Most patients can resume normal activities within two to three weeks, but strenuous activities should be avoided for at least four to six weeks. Visible swelling and bruising usually subside within a few weeks, though subtle swelling may persist for a few months. Final results and significant scar fading generally take one to two years, depending on procedures performed, individual healing rates, and adherence to aftercare.